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Author Topic: Help please - MRI "clear", but still have knee pain  (Read 7237 times)

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Offline gooner

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Help please - MRI "clear", but still have knee pain
« on: January 01, 2011, 09:39:30 PM »
Hi,

I'm looking for some advice, please....

I had a bilateral scope to tidy the cartilage in three place on each knee back in Oct 2008. After extensive physio I eventually returned to sport in around 6 months.

There has been a gradually increase in pain and discomfort over the last year and neither knee is great but far worse in left. Usual issues with pain and stiffness first thing in the morning, on sloped ground and after sitting for a while. Discomfort most noticeable when leg is fully extended and weight bearing. Also had what feels like a click/re-alignment in left knee which was sharp enough pain to momentarily stop me walking until the click had happened.

I was referred for physio and have been working over the last couple of months on re-strengthening muscle groups around the left knee. PT believes muscles are in reasonable shape now and diagnosed PFPS from positive Clarkes test and possible tear from McMurray, mal-tracking was also evident. The OS confirmed the mal-tracking. The pain etc. is still there and I had dynamic tracking and static MRI scans. Neither of which showed up much apart from some degenerative signal in the menisci (lateral anterior and medial posterior) - no firm evidence of any tears and the tracking sequences showed nothing significant.

I don't know what my next conversation with the OS should be:

- how can the MRIs can be "clear" when maltracking have both been independently indicated and the pain continues, something must be wrong
- OS says there are things that can be done
   - what might this be ?
   - and for what problem ?
- can I get the MRIs re-checked [elsewhere maybe?] (I have the discs)

Any thoughts or maybe similar experiences welcome - thanks !

J.

cdubb

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Re: Help please - MRI "clear", but still have knee pain
« Reply #1 on: January 02, 2011, 01:09:49 AM »
I would speculate that the things that can be done are realignment surgeries depending on what your malignant issues are. Most likely would be a tibial tuburcle osteotomy. I also have bilateral PF problems with grade 4 chondral defects on the patella with some maltracking issues(likely cause of chondral injury). I am a little over 8 weeks out of a tibial tuburcle osteotomy with an ACI to repair the damaged cartilage. I had prior lateral releases in '01 and '03 to help with the lateral tilt..that alone didn't do much and I probably should have pursued more aggressive measures such as the TT back then because now I have 2 trashed kneecaps at 31 years old. Although...how do you really predict who with PF problems will develop into grade 4 chondromalacia and who won't?

Offline gooner

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Re: Help please - MRI "clear", but still have knee pain
« Reply #2 on: February 01, 2011, 07:14:26 PM »
Thanks cdubb.

I've now been to see the OS and he advised that there is no good indication for surgery just now as the MRI itself showed nothing significant, though problems may be found if he were to scope my knees. He believes that there is some patello-femoral chondral damage and referred me for more physio for 8 weeks before a further scope and possible LR on each knee but one at a time !

The mal-tracking is not severe and I really don't want to go down the LR or any other surgical road just yet. I'm seeking a second opinion as discussions with the PT suggest there could be other treatments which factor in the arthritis (I have psoriasis also) and overall degenerative condition. There is an audible click on McMurrays on the left and some grinding on the lateral side of the right knee.

A couple of questions:
1) does anyone have any experience of either Sam Church or Charles Gibbons at Chelsea and Westminster hospital ?
(they both seem to have an interest in arthritis of the knee and Sam Church on anterior knee pain)
2) many on the board have had an LR and most seem to have problems. As a result do we think that they are going out of favour amongst the OS community ?

Thanks


J.
 





Offline gooner

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Re: Help please - MRI "clear", but still have knee pain
« Reply #3 on: March 20, 2011, 12:43:18 AM »
Mystery solved !

I sought a second opinion and my new OS sent me for further scans.
All of which revealed my tracking is "normal" yet there is some tendonitis but most revealing of all was three lesions:
> Grade 2/3 median ridge mid zone 20mm x 16mm and this is seen to extend more laterally
> Mid trochlea groove Grade 1/2  16mm x 12mm
> Grade 3/3b mid anterior mid zone and mid posterior MFC 28mm x 25mm

Quite why these lesions never showed (or weren't identified) on the original extensive MRI images is unknown.
Anyway, I have been back to see the OS and I'm now booking in surgery to fix / regen the cartilage towards the end of April.
Really pleased to have some answers at last and looking forward to hopefully getting fixed, albeit around a year before the cartilage is sorted.

I'll post my diary when the time comes. Focus is on just one knee for now, no doubt I'll need to sort the other out before too long.

Cheers


J
« Last Edit: March 20, 2011, 12:47:07 AM by jdb_gooner »

Offline Lottiefox

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Re: Help please - MRI "clear", but still have knee pain
« Reply #4 on: March 20, 2011, 11:07:01 AM »
Yay! Got your email, and will reply later. Good news. That T2 3-D imaging is the best and Mr S's radiologist is simply awesome. Good luck with the op, you're in very good hands. Will try and get Nathan in touch with you via facebook too and email more of my best wishes.

So glad you got some progress, and no LR!! Wooohooo!!

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline emergRN

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Re: Help please - MRI "clear", but still have knee pain
« Reply #5 on: March 20, 2011, 06:17:29 PM »
Can I ask what kind of scans you had after your initial negative MRI?  Thanks ;D

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline gooner

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Re: Help please - MRI "clear", but still have knee pain
« Reply #6 on: March 20, 2011, 09:48:37 PM »
Sure yes: I had another MRI, the DVD browser contains these image sets (presumably someone on KG can translate, I recognise that some relates to the planes through which the images are being taken and of course ACL - otherwise ... er, well, erm ! ;D
These MRIs were much quicker about 25 -30 mins rather than 90 mins for the original, inconclusive, scans.
localiser_tra
localiser_sag+cor
pd_tse_fs_tra_320
t2_me2d_sag_3mm
t1_se_sag_320_3mm
t2_de3d_sag_320
pd+fs_tse_cor
pd_tse_sag_448 FOR ACL

I also had a CT tracking scan and a SPECT scan, oh and a few days after a Doppler scan as well - as there was a "filling error" on the MRI and the radiologist was checking that it was not a clot - luckily it wasn't.

Offline Lottiefox

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Re: Help please - MRI "clear", but still have knee pain
« Reply #7 on: March 20, 2011, 10:20:06 PM »
Blimey you've been scanned every which way but loose!  8)

I think it also helps that this OS has a very good relationship with the radiologist, they discuss what the OS wants to look for prior to the scanning, then sit down and talk through the scans to help the OS plan the surgery before he follows up with the patient. It is proper joined up working, with a specialist knee surgeon and a very experienced radiologist who knows what to look for. The detail of measurement is critical, as it informs the OS which particular repair he can use, and he has several options not available to many other docs in the UK. Size is everything (pnar pnar said the actress to the bishop... :P)

Did you do the CT scan with the quads tensed and relaxed at various angles? OMG on one of those angles I found it so hideous on the left knee, it just pinched my poor bare kneecap section! Ouch!

Lottie
 
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline emergRN

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Re: Help please - MRI "clear", but still have knee pain
« Reply #8 on: March 20, 2011, 10:22:09 PM »
Thanks!  I think the coding that you have there with reference to your MRI are the different spins that they do.  Coronal, saggital(Spelling)etc.  My MRI's have been 20-30 minutes.  It was a T2 scanner.

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline gooner

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Re: Help please - MRI "clear", but still have knee pain
« Reply #9 on: March 20, 2011, 10:46:49 PM »
I think I have had the full menu of available scans. As you say the OS and radiologist are a real team, they have worked together for sometime including a spell in a London hospital.

Yes, I did the dynamic CT tracking scan at different angles with flexed quads - I do remember them being really uncomfortable. The 3D pictures that were generated were amazing - I'll try and upload them tomorrow. My MFC lesion is at about the max possible for one of the treatments, so I'm lucky there !

.. speaking of being lucky ... with the OS, the radiologist and my PT, I feel like I have a great team looking after me ..... I'm so thankful for that.  With the support of KG members available too, what more does a man need to sort out his rubbish knees !
Have tried to take an interest in the knees as well. Figured it could only help if I had at least some understanding of what was happening down there and how I'm put together.


J

Offline emergRN

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Re: Help please - MRI "clear", but still have knee pain
« Reply #10 on: March 20, 2011, 10:49:59 PM »
I am just full of questions!!  Did you require IV contrast for the CT?  Did it involve any injections into the knee joint?  Thanks again ;D

W
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline gooner

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Re: Help please - MRI "clear", but still have knee pain
« Reply #11 on: March 20, 2011, 10:58:01 PM »
No, there weren't any contrast injections needed for the CT scan.
Had some radioactive "stuff" (that's a technical term !) injected for the SPECT scan.

the warning info tells you to avoid getting to close to anyone who is pregant and that you may set off the airport scanner. Guys at work thought it was hilarious and swore that I had a green halo  ;D


Offline gooner

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Re: 3D images - wot no joint space !
« Reply #12 on: March 21, 2011, 11:49:05 PM »
Here are some 3D images generated during my CT tracking scan, thought you'd like to see them:
I can't tell at what point in the sequences they were taken but they show:

a) patellar in groove


b) knees from rear (medial joint space has clearly gone AWOL)


c) knees from front (medial joint space has clearly gone AWOL)


« Last Edit: March 21, 2011, 11:51:09 PM by jdb_gooner »

Offline emergRN

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Re: Help please - MRI "clear", but still have knee pain
« Reply #13 on: March 22, 2011, 12:05:03 AM »
Very Cool!!!
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline gringodeotropais

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Re: Help please - MRI "clear", but still have knee pain
« Reply #14 on: May 22, 2012, 03:26:34 PM »
Hi Gooner,

I have just been referred to Mr. Gibbons at Chelsea and Westminster and when I googled his name your post and another came up, I hope you don't mind me contacting you directly.  I have chondroamcia patella, seemingly caused by a long history of mal tracking and an unstable knee.  The referral is to see if surgery is appropriate and if so, what type. 

Did you have surgery in the end with Mr. Gibbons? Would you recommend him? Or is there someone else in the department you think I should try and get referred to?

Thanks in advance for your time! You know what this is like!

Joe















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